Additional possible reasons for increased markers of inflammation in the ESRD population include 1) uremia-related alterations in immune/host defense systems, specifically increased cytokine production, 2) increased oxidative stress (oxidized-LDL), advanced glycation end products (AGEs) 3) the dialysis membrane (IL-6 and IL-1 β production by certain membranes), 4) contaminated dialysate, [ultrapure dialysate reduces CRP levels],5) intercurrent clinical events, 6) and occult arteriovenous graft infection, 7) protein-energy malnutrition, and 8) shorter time on hemodialysis (HD). (8-13). None of the above CRP associated mortality studies controlled for type of vascular access. There are reports of an association of vascular access type with other markers of inflammation. Kaysen et al report an association between low levels of serum albumin with presence of an AVG, and Thadani et al recently reported elevated WBC count and hemocatheters (14,15).